International Conference on
Infant, Toddler and Preschool
Mental Health
Programme
Table of Contents
Our Sponsors
3
Conference Timetable
4
Abstracts of Presentations
8
Our Speakers
15
Poster Abstracts
25
Floorplans
43
We gratefully acknowledge our Sponsors!
The Conference has benefited from grants made available by both The Maori
Health Directorate and The Ministry of Social Development. These grants have
encouraged participation from a wide range of providers of services which are
closely aligned to the support of infant, toddler and preschool mental health. The
recipients of these grants are practitioners working with our most vulnerable infants
and their participation is valued at this event.
The Maurice and Phyllis Paykel Trust have sponsored our Poster Presentation
Session and our sincere thanks are extended to the Trust for their assistance for
that purpose.
We are grateful also to UniServices, for sponsorship of the welcome at Waipapa
Marae which was attended by many of our international speakers, delegates and
distinguished guests.
Our thanks also go to the ASB. Professor Barry Lester, who has been instrumental
in the conception and delivery of this programme, is the 2011 ASB Visiting
Professor to the Department of Psychological Medicine, which has enabled us to
take full advantage of his presence in Auckland.
Conference Timetable
POWHIRI AND RECEPTION
Wednesday, 17th February
5.15 pm
Powhiri at Waipapa Marae followed by Reception
Corner of Alten Road and Wynyard Street
CONFERENCE PROGRAMME
Owen G Glenn Building, Room 098
The University of Auckland Business School
12 Grafton Road
DAY ONE Thursday, 18th February
Morning Session
8.00 – 9.00
Registration in the Foyer, Level 1
9.00 – 9.45
Mihi Whakatau, Welcome—Rawiri Wharemate
Co-Convenors’ Welcome—Trecia Wouldes, PhD and Barry Lester, PhD
9.45 – 10.15
Morning Tea in the Foyer
10.15 – 11.00
Opening Speech—The Honourable Tariana Turia
Minister for the Community and Voluntary Sector, Associate Minister of Health,
Associate Minister for Social Development and Employment and Minister for Disability
Issues.
11.00 – 12.30
Keynote Address—Edward Z. Tronick, PhD
“Infants and Young Children as Makers of Meaning About Themselves in
Relation to People, Things and Themselves”
12.30 – 1.30
Lunch in the Foyer
Afternoon Session: Relationship Disorders
1.30 – 2.30
Speaker: Ruth Feldman, PhD—“The Neurobiology of Parent-Infant Attachment
in Normative and High Risk Development”
2.30 – 3.30
Speaker: Louise Newman, FRANZCP—“Mothers, mirrors and reflective
functioning: trauma in early infant-parent relationships”
3.30 – 4.00
Afternoon Tea in the Foyer
4.00 – 5.00
Speaker: Denise Guy, MBChB, FRANZCP—“Watch, Wait and Wonder – the
space for developing parental reflection to promote change”
5.00 – 6.30
Reception and Poster Presentations in the Foyer
DAY TWO Friday, 18th February
8.30 – 9.00
Registration in the Foyer
9.00 – 9.40
Plenary Presentation: Barry Lester, PhD—“Fetal Origins of Infant Mental Health
Disorders”
Morning Session: Early Conduct Problems
9.40 – 10.30
Speaker: Daniel Shaw, PhD—“The Development and Validation of an
Intervention to Prevent Early Conduct Problems: The Family Check Up”
10.30 – 10.50
Morning Tea in the Foyer
10.50– 12.00
Speaker: Frances Gardner, PhD—“Effectiveness of early parenting interventions
for child problem behaviour: Translating research evidence into the real world”
12.00 – 12.50
Speaker: Cheryl McNeil, PhD—“Parent-Child Interaction Therapy”
12.50 – 1.30
Lunch in the Foyer
Afternoon Session: Preterm Infants
1.30 – 2.30
Speaker: Lianne Woodward, PhD—“Children Born Very Preterm: A Double
Hazard Population”
2.30 – 3.30
Speaker: Rosemarie Bigsby, ScD, OTR/L, FAOTA –“Fueling Preterm Infant
Development Through Family-Based Interventions in the NICU”
3.30 – 4.00
Afternoon Tea in the Foyer
4.00 – 5.00
Speakers: Louise Webster MBChB, FRANZCP, FRACP(Paeds) Toni Shepherd
NZDB, B.Com, Grad Dip Psych. NZAP, MNZAC, Waka Oranga, and Leah
Andrews M.B., Ch.B., FRANZCP, PG Cert Clin Ed—“Who Owns This Baby?”
6.30 – 9.30
Conference Dinner: BBQ at the Fale Pasifika
DAY THREE Saturday 20 February
8.30 – 9.00
Registration in the Foyer
9.00 – 9.40
Plenary Presentation: Linda LaGasse, PhD—“Infant Development,
Environment and Lifestyle (IDEAL) Study: Impact of Prenatal
Methamphetamine Exposure on Child Development”
Morning Session: Autistic Spectrum Disorder
9.40 – 10.30
Speaker: Cheryl Dissanayake, PhD—“Promoting the early identification of
infants and toddlers with an Autism Spectrum Disorder”
10.30 – 10.50
Morning Tea in the Foyer
10.50– 12.00
Speaker: Todd Levine, MD—“Psychiatric Evaluation of Children with
Autism Spectrum Disorders”
12.00 – 12.50
Speaker: Steve Sheinkopf, PhD--“Identification of autism in infants and
toddlers: clinical approach and research strategies”
12.50 – 1.30
Lunch in the Foyer
Afternoon Sessions: 1:30-3:30
These afternoon sessions will be run in parallel and located in breakout rooms adjacent to the lecture
theatre. These will be run as workshops where it is hoped you will share your individual expertise and ideas
about the delivery of services to Infants, Toddlers and Preschool Children.
Venue: Level 0, Business School
Maori Models for Infant Mental Health
Case Room 2 (260.055)
Speakers: Tania Cargo, MA, PGDipClinPsych, Lyn Doherty,—“Awhitia
ngā Hākuitanga Hākorotanga: Cherishing the living breath of our
ancestors.”
Pacific Islands Families Study Symposium
Case Room 3 (260.057)
Speakers: Janis Paterson, PhD, Gerhard Sundborn, PhD, El-Shadan
Tautolo—“Pacific Islands Families Study Symposium: Aspects of Mental
Health”
Mental Health Policy and Services for Infants, Toddlers and Preschool
Children
Room OGGB3 (260.092)
Speakers: Colin Hamlin, Senior Advisor, Policy and Service
Development, NZ Ministry of Health, Sally Merry, MBChB, FRANZCP, MD,
Jo Chiplin, BHSc, MMgt (Health Services)—“Now we know what works in
perinatal and infant mental health, what next?”
3.30 – 4.00
Closing Comments and Poroporoaki/Farewell
Abstracts of Presentations
DAY ONE Thursday, 18th February
Keynote Address:
Infants and Young Children as Makers of Meaning About Themselves in Relation to
People, Things and Themselves
Edward Z Tronick, PhD
Infants and children are makers of meaning about themselves in relation to people, things and themselves.
The meanings they make shape their developmental pathways for good or ill mental health. But unlike adults
who make symbolic meanings infants meanings are emotional and somatic. Using video tapes of infants
and children making and failing to make meaning, including infants and children in the still-face paradigm
and playing games, we will explore the consequences for typical and atypical development, culture and the
effects of stress and psychopathology.
Relationship Disorders
The Neurobiology of Parent-Infant Attachment in Normative and
High Risk Development
Ruth Feldman, PhD
The parent-infant bond provides the foundation for children's social, emotional, and cognitive growth.
Processes of bond formation are expressed in unique parental behaviors that involve the parent's close
adaptation to the infant's non-verbal cues and are supported by specific physiological systems. In this talk, I
will describe the parent-infant behavioral repertoire and interaction synchrony and its contribution to infant
development across childhood and adolescence. Recent findings from our lab on the neuropeptite Oxytocin
(OT), which has repeatedly been implicated in processes of bond formation in mammals, and its involvement
in human attachment will be presented, including the assessment of OT across pregnancy, comparison of
mothers and fathers at the transition to parenthood, the effects of parent-infant touch on OT release, and the
disruptions to the oxytocinergic systems in cases of maternal postpartum depression. These data highlight
the involvement of OT in human attachment, the associations between OT and parent-infant synchrony and
touch, and the cross-generation transmission of the neurobiology of parenting. Three high-risk conditions
that disrupt the bonding process by reducing maternal availability to the infant are examined as unique
windows to assess the effects of maternal deprivation on the neurobiology of attachment: (a) prematurity, (b)
maternal post-partum depression, and (c) war-related trauma. I will present longitudinal data demonstrating
the effects of each condition on maternal and infant physiology, the mother-child relationship, and the
infant's emotion regulation. Finally, I address the role of touch in the formation of attachment relationships
by presenting results from a 10-year longitudinal study on the effects of skin-to-skin contact (Kangaroo Care)
during the neonatal period on the development of premature infants. The talk concludes by discussing the
implications of early maternal unavailability on the child's capacity for social affiliation throughout life and the
relevance of the findings for the development of specific interventions in infancy.
Mothers, mirrors and reflective functioning: trauma in early
infant-parent relationships
Louise Newman, FRANZCP
Early relational trauma impacts infant psychosocial and neurobiological development. Parents with
unresolved traumatic experiences and conflicts regarding the self-as-parent may experience fundamental
difficulties in ‘reading’ and responding to the emotional communication of their infant and in reflecting on the
inner world or subjectivity of the infant. These distortions of early mirroring and emotional interaction result
in confusing experiences for the infant, of being ‘misunderstood’ or ‘misperceived’, and if persistent, disrupt
early development of the self. Parents with a background of attachment-related trauma may also re-enact
past trauma in the relationship with the infant who may be identified with past traumatic attachment figures.
Reflective capacity and the capacity to understand the infant’s emotional world is also disrupted by past
trauma suggesting that this should be a focus for therapeutic intervention with high risk dyads.
Watch, Wait and Wonder – the space for developing parental reflection
to promote change
Denise Guy, MBChB, FRANZCP
A significant ‘road’ to ensuring social, emotional and behavioural change for symptomatic infants and
preschoolers is to promote their developing a secure attachment. Parental reflective capacity has emerged
as the most significant factor underlying the parent’s ability to support this for their child. Interventions
utilising the research on reflective capacity, reflective function and mentalisation are demonstrating
effectiveness beyond that achieved by a focus on improving parental sensitivity. The understandings from
this research can be utilised to improve intervention outcomes as will be discussed with reference to a childled dyadic intervention that deliberately creates a space for thinking about the minds of others and is known
to improve the security of attachment.
DAY TWO Friday 18th February
Plenary Presentation:
Fetal Origins” of Infant Mental Health Disorders
Barry Lester, PhD
Advances in biology have changed the way we think about infants at risk. We learned from the "fetal origins"
literature that nutritional compromise in utero is associated with adult metabolic and other disorders and
there is increasing evidence for similar associations with mental health disorders. Although fetal
programming processes are thought to be involved, the specific mechanisms are not known. The heuristic
model presented here suggests one pathway for understanding how altered fetal programming results in the
later development of mental health disorders. Drawing from work on the effects of prenatal cocaine
exposure, the model suggests that prenatal stress alters the expression of key placental genes that affect
the fetal neuroendocrine system through epigenetic mechanims. The combination of this biological
embedding of prenatal insult with an environmentally toxic postnatal environment creates chronic wear and
tear on the neuroendocrine system resulting in the development of behavior disorders.
Early Conduct Problems
The Development and Validation of an Intervention to Prevent Early Conduct
Problems: The Family Check Up
Daniel Shaw PhD
The talk will begin with a review of theoretical and empirical work on pathways of early-starting conduct
problems, highlighting findings from the author’s own 20-year longitudinal study of toddlers at risk for earlystarting pathways and convergent findings from other relevant studies. Next, the chasm between basic
research and translating this knowledge to the world of prevention science will be discussed, including the
inherent challenges in using knowledge gained from basic research in real world settings. The final part of
the talk will introduce the Family Check Up as a vehicle for bridging this chasm and creating the climate of
change for families with young children at high risk for early-starting pathways. Findings from two
longitudinal trials examining the efficacy of the Family Check Up will be presented, including expected and
unexpected collateral effects on child and parent outcomes.
Effectiveness of early parenting interventions for child problem behaviour:
Translating research evidence into the real world
Frances Gardner PhD
This talk will examine the extensive evidence base from many countries for the effectiveness of early
parenting programmes: for whom do they work and how, for what problems, in what contexts; to what extent
do they work in 'real world' service settings, with diverse cultures, and with disadvantaged and marginalised
populations? Can evidence-based parenting interventions be taken 'to scale'? What are some of the
challenges and possibilities in trying to do this? The talk will draw on Professor Gardner’s experience of
conducting randomised controlled trials of parenting interventions for preventing and treating conduct
problems in various service contexts in England, Wales and the USA, as well as literature from other parts of
the world.
Parent-Child Interaction Therapy
Cheryl McNeil, PhD
Early intervention for children with severe behavior problems has been found to improve their long-term
outcomes. This workshop describes Parent-Child Interaction Therapy (PCIT), an intervention that has
documented effectiveness for helping parents manage aggression and defiance in young children (2 to 7
years). PCIT is unique in that it is a short-term parent training approach that involves direct coaching of
parent-child interactions. Parents receive immediate feedback in such areas as praising appropriate
behavior, interacting at the child’s developmental level, ignoring inappropriate behavior, giving good
instructions, and teaching children to stay in timeout. In PCIT, behavioral techniques are integrated with
traditional play therapy skills to enhance parent-child relationships. This workshop will appeal to mental
health professionals who work with physically abusive parents and/or preschoolers from various cultural
backgrounds who are overactive, defiant, and aggressive.
Preterm Infants
Children Born Very Preterm: A Double Hazard Population!
Lianne Woodward, PhD
Approximately 1-2% of live births are very preterm (<32 weeks’ gestation), and with advances in medical
care the majority of these infants now survive (> 85%). In contrast, morbidity rates have not improved with
more than 50% of very preterm survivors subject to later, clinically significant, neurodevelopmental
challenges that impact a child’s school progress and life course opportunities. This aim of this presentation is
to provide an overview of recent Australasian and international research developments relating to the longer
term challenges that children born very preterm and their families may face, as well as the clinical,
neurological and socio-contextual processes that contribute to later risk. The importance of a developmental
perspective will be emphasised as well as the need to recognise the double, biological and social, hazard
nature of this population.
Fueling Preterm Infant Development Through Family-Based Interventions
in the NICU
Rosemarie Bigsby, ScD, OTR/L, FAOTA.
The Neonatal Intensive Care Unit (NICU) presents unique challenges for preterm infants, as well as for
every member of the care team, especially parents. In this presentation, a psychosocially-based model of
care will be discussed. This contextual model for intervention acknowledges the occupational roles,
developmental tasks and cultural expectations for infant, parent and staff alike, all of which influence our
ability to optimize development for fragile infants. Strategies for enhancing parent participation in
developmental assessment and evidence-based interventions will be presented, including early initiation of
nurturing touch and breastfeeding. Advantages of and issues arising from the recent move from open-bay to
single-family room NICU environment will also be discussed.
Who Owns This Baby?
Louise Webster MBChB, FRANZCP, FRACP(Paeds) Toni Shepherd NZDB, B.Com, Grad Dip Psych. NZAP,
MNZAC, Waka Oranga and Leah K. Andrews M.B., Ch.B., FRANZCP, PG Cert Clin Ed
Neonatal medicine and the care of very sick preterm babies has advanced significantly in the past 20 years,
with increased survival rates of very low birth-weight infants who would previously have died. The
importance of ‘family centred care’ and the placing of the infant and family at the centre of the care process
have also received increasing recognition in recent years, with most New Zealand NICUs aiming to provide
family centred care. There are however many obstacles to this process, and many parents still talk of feeling
that their baby does not belong to them during neonatal care. NICU staff may find it more challenging to
engage in family centred care with indigenous families and immigrant families, particularly when those
families are having to manage other stresses and disadvantages in addition to the birth of a preterm infant.
In this presentation we review the development of family centred care and discuss the issues that make this
challenging for services to deliver in the current environment. We also discuss issues that are important to
indigenous families who are parenting a preterm infant in a NICU.
DAY THREE Saturday 20 February
Plenary Presentation:
Infant Development, Environment and Lifestyle (IDEAL) Study: Impact of Prenatal
Methamphetamine Exposure on Child Development
Linda LaGasse, PhD
Methamphetamine (MA) use is a world-wide public health problem with recent reports of approximately 250
million users, exceeding cocaine and heroin combined. MA use among pregnant women is of great concern
because little is known about the impact of MA on the fetus. We are conducting the first prospective,
longitudinal study (IDEAL) of MA use and child outcome from birth to age 3 years in the US and Auckland,
NZ. The purity of MA, health care, financial supports, and mandatory child removal for prenatal drug use
differ between the US and NZ and offer an opportunity to determine how the child rearing environment may
shape development of MA exposed children. Despite greater adversity reported by US versus NZ mothers,
we find no increase in medical problems or birth defects in MA exposed newborns and a similar pattern of
subtle neurobehavior deficits associated with MA exposure. By age 3 years in the US cohort, there are no
deficits associated with MA exposure on developmental status, language, motor performance or behavioral
problems. But these null results may be deceiving! In our study of cocaine exposed children, we observed
relatively few effects in the first 3 years, but during school age, cocaine exposed children had more IQ
deficits, special education, externalizing behavior and psychopathology. These findings could reflect brain
maturation of areas initially affected by prenatal exposure but may also result from vulnerable children
growing up in adverse environments. The IDEAL study provides a means to untangle exposure from
environment to develop effective interventions in children with prenatal drug exposure.
Autistic Spectrum Disorder
Promoting the early identification of infants and toddlers with an
Autism Spectrum Disorder
Cheryl Dissanayake, PhD.
A brief overview of the evidence on the signs of autism in infancy will be given based on the results of
retrospective home video and parent report studies, as well as from prospective studies of high risk infant
siblings and the few available community-based studies. Although to date no primary level instrument has
proved sufficiently robust to recommend universal screening, it will be argued that the problem lies in the
approach of using a one-off screen at a given age. A developmental surveillance approach, where infants
are monitored regularly throughout their first two years for the development of early social attention and
communication behaviours by primary health care professionals will be recommended. The results from a
large community based study in Melbourne using this approach will be reported which has resulted in an
81% ascertainment rate for ASD, with the remaining children (with one exception) either having a
developmental and/or language delay. The need for education on the early signs of autism of primary care
professionals will be emphasized, as the value of early identification and intervention cannot be
underestimated.
Psychiatric Evaluation of Children with Autism Spectrum Disorders
Todd Levine, MD.
Children with Autism Spectrum Disorders (ASDs) are recognized as having multiple behavior problems
including those related to attention, disruptive behaviors, and anxiety. Reducing these symptoms is
important to maximizing learning and functional potential in these children. However, understanding
psychiatric problems in the context of children with deficits in communication and socialization, along with
repetitive behaviors and interests, provides particular challenges, especially in very young children. We will
explore how psychiatric symptoms may present differently in children with ASDs and how to categorize them
to help in treatment planning. We will also discuss the importance of delineating symptoms of ASDs from
co-occurring disorders. Therapeutic options will be explored, including medication strategies.
Identification of autism in infants and toddlers: clinical approach and
research strategies
Steve Sheinkopf, PhD
While the presentation of autism is highly atypical and readily identifiable by early childhood, the disorder
can be subtle in its presentation during the toddler period. Despite recent advances, it has been especially
difficult to identify very early signs of autism in infancy. This has significant implications for both clinical
practice and research. The nature of autism’s early presentation, coupled with individual differences in early
development complicate differential diagnosis in the toddler period. The identification of signs of autism in
early infancy has been particularly challenging. Early indicators of social functioning have been found by late
in the first year of life, but remain quite elusive in infants under 6 months of age. This lecture will review
approaches to early diagnosis in toddlers, as well as novel approaches to studying potential signs of autism
in early infancy. Videotape examples of infants and children with autism, as well as those with typical
development, will be used to illustrate important concepts. Preliminary results from ongoing research on
autism in early infancy will also be reviewed.
Maori Models of Infant, Toddler and Preschool Mental Health
Awhitia ngā Hākuitanga Hākorotanga: Cherishing the living breath of our ancestors.
A Māori mana-enhancing and practical tuakana-teina parent coaching programme,
aimed at treating severe behavioural difficulties in very young children
Tania Cargo, MA, PGDipClinPsych, Lyn Doherty
The importance of the earliest relationship between parents and infants is well documented in Māori history.
Literature from the early 1800’s reveals how highly valued Māori babies and very young children were in
whānau, whilst oral histories and whakatauākī provide evidence of cultural values associated with early
parent-infant relationships. “Nā te moa i takahi te rātā: the young rātā when trodden on by a moa will never
grow straight” is a whakatauākī which illustrates the importance of the earliest relationship and demonstrates
the long term consequence of abusive early parenting. In Aotearoa today most Māori babies grow up in
mana-enhancing whānau were they are nurtured into happy, healthy, fully contributing adults. Unfortunately
there is also a disproportionate number of our whānau who are struggling and under resourced, whose
beautiful Māori babies are being diagnosed with a variety of “disruptive behavior disorders” which often
predict a negative future pathway, if effective interventions are not implemented early. During this
presentation you will hear about my PhD research “Awhitia ngā Hākuitanga Hākorotanga”, which aims to
support our most vulnerable Māori parents and their infants through a mana-enhancing, sensitiveresponsive, practical tuakana-teina parent coaching programme. Come along to share the kōrero o mua,
kōrero whakakakata me kōrero pono.
Pacific Islands Families Workshop and Symposium
Pacific Islands Families Study Symposium: Aspects of Mental Health
Janis Paterson, PhD, Gerhard Sundborn, PhD, El-Shadan Tautolo
The Pacific Islands Families Study (PIF) is a large scientifically and culturally robust longitudinal study that is
following a birth cohort of approximately 1000 Pacific children and their families in order to track child and
family development and wellbeing. To date, parent and child assessments have been carried out at 6weeks, 12-months, 24-months, 4-years and 6-years of age. The overall aim of the PIF study is to determine
the pathways leading to successful adaptation as the cohort and their families negotiate critical
developmental transitions, notably the key developmental stages of infancy and childhood, transitions to
early education and school, and the influence of the socio-cultural context and family environment on Pacific
children.The rich longitudinal PIF data, provides a unique opportunity to examine multiple exposures on a
range of health and developmental outcomes, contributing significantly to public health and environmental
epidemiology and the health of New Zealand children. In this presentation we will (1) give an overview of the
PIF Study, (2) present findings in the areas of postnatal depression, child behaviour problems, mental health
of Pacific fathers, and (3) describe future directions as the children in the cohort develop towards
adolescence
Policy and Service Provision Workshop and Symposium
Now we know what works in perinatal and infant mental health, what next?
Colin Hamlin, Senior Advisor, Policy and Service Development, NZ Ministry of Health
Sally Merry, MBChB, FRANZCP, MD
What can be done at a national level, at a local level and at a service level?
This presentation describes the way the New Zealand Ministry of Health, informed by evidence of what
works, is considering perinatal and infant mental health and development. It also looks at where perinatal
and infant mental health fits with Government health priorities and suggests a way forward for service
development in the current economic environment.
An initiative to address infant mental health problems in an integrated way across at Counties Manukau
District Health Board will be described. Work has been planned by a multidisciplinary group across primary,
secondary and tertiary healthcare. This has resulted in a number of projects including the creation of “Look
at You, Aroha Atu, Aroha Mai” a DVD to provide education about early social and emotional development
(based on the Australian DVD “Getting to Know You”), research on effective parenting interventions for
families in the District Health Board (Hoki ki te Rito and Hukuitanga, Hakorotanga) and the development of a
new infant mental health service, Whakatupu Ora. The challenges of setting up an evidence based
specialist service that meets the needs of the local community and the ways in which we have tackled this
will be discussed.
Speaker Profiles
CONVENORS OF THE CONFERENCE
Trecia Wouldes, PhD
Dr. Wouldes is a Senior Lecturer In the Department of Psychological Medicine
at the University of Auckland, New Zealand and a Member of the Executive
Leadership of The Werry Centre for Child and Adolescent Mental Health
Dr. Wouldes main research interests are the development of children born to
mothers who have used psychoactive drugs during their pregnancy and the
development of Infant Mental Health services that will address the needs of
the mothers and infants in these high risk populations. Todate her research
has investigated the effects of methadone on the development of the fetus
and infant and she is currently the Auckland P.I. of the multi-site IDEAL Study
which is investigating the development of infants and young children born to
mothers who use methamphetamine “P” during pregnancy. Trecia has
developed two infant mental health courses for postgraduates enrolled in the
Werry Centre Child and Adolescent Mental Health programme.
Barry M. Lester, PhD
Dr Lester is Professor of Psychiatry & Human Behavior and Pediatrics at
Brown Medical School, USA
Dr. Lester is founder and Director of the Center for the Study of Children at
Risk at the Alpert Medical School of Brown University and Women & Infants
Hospital. The Center conducts research and provides treatment services for
an array of populations of infants at risk and their families. The Center also
provides training in research, clinical assessment and treatment. Dr. Lester’s
research is on the study of processes and mechanisms at the intersection of
biological and environmental factors that determine developmental outcome in
at risk and typically developing children. Dr. Lester has been a member of NIH
study sections and of the National Advisory Council on Drug Abuse at NIDA.
He is past president of the International Association for Infant Mental Health
and the author of more than 200 scientific publications and 16 edited books.
KEYNOTE
Ed Tronick, PhD
Edward Z. Tronick, PhD. University Distinguished Professor
University of Massachusetts Boston, Child Development Unit
Children’s Hospital, Boston, Harvard Medical School
Dr. Tronick is a world class researcher and teacher recognized internationally
for his work on the neurobehavioral and social emotional development of
infants and young children, parenting in the U.S. and other cultures, and
infant-parent mental health. He developed the Face-to-face Still-face
paradigm and video-taped micro-analytic studies of infant en face interactions,
pioneered studies of the effects of maternal depression on infants, and carried
out numerous cross-cultural studies of infant and child development. His
Mutual Regulation Model and Dyadic Expansion of Consciousness hypothesis
are widely accepted accounts of social interactions and therapeutic
processes.
SPEAKERS
Ruth Feldman, PhD
Ruth Feldman, PhD is a professor of psychology and neuroscience at BarIlan University, Israel with a joint appointment at Yale University Medical
School, Child Study Center
She is the director of the community-based infancy clinic at Bar-Ilan and the
head of the Irving B. Harris internship program in early childhood clinical
psychology. She has published more than 100 scientific papers in
prestigious journals and is on the editorial board of several high-ranking
journals in child development and child psychiatry. Her research focuses on
the biological basis of bonding, parent-infant relationship, bio-behavioral
processes of emotion regulation, the development of infants and young
children at high risk stemming from biological (e.g., prematurity), maternal
(e.g., postpartum depression), and contextual (e.g., war-related trauma) risk
conditions, and the effects of touch intervention for premature infants. For
over a decade she has been involved in conducting developmental research
and intervention programs for Israeli and Palestinian children exposed to
repeated war, terror, and violence.
Louise Newman, PhD
Louise Newman. Professor of Developmental Psychiatry & Psychology at
Monash University, Australia
Dr. Newman is the Director of the Monash University Centre for
Developmental Psychiatry & Psychology. Prior to this appointment she was
the Chair of Perinatal and Infant Psychiatry at the University of Newcastle.
Dr. Newman is a practicing infant psychiatrist with expertise in the area of
disorders of early parenting and attachment difficulties. Her current research
focus is the evaluation of infant-parent interventions in high-risk populations,
the concept of parental reflective functioning in mothers with borderline
disorders and the neurobiology of parenting disturbance.
Denise Guy, MBChB, FRANZCP
Denise Guy is a Child and Adolescent Psychiatrist with clinical expertise in
infancy and early childhood. Her current roles include clinical supervision
around infant and child mental health, Clinical Advisor for High and Complex
Needs, Vice Presidency of the NZ Affiliate of the World Infant Mental Health
Association, training within Australasia in the Watch, Wait, and Wonder™
Intervention and she is a Trustee of the Incredible Families Charitable Trust .
Daniel Shaw, PhD
Daniel Shaw, PhD. Professor of Psychology and Psychiatry at the
University of Pittsburgh, USA
Dr. Shaw’s research and clinical focus involves tracing the early
developmental precursors of externalizing and internalizing problems among
at-risk children. Dr. Shaw has published extensively on risk factors
associated with the development and prevention of conduct problems in
early childhood. He currently leads or co-directs five NIH-funded,
longitudinal studies investigating the early antecedents and prevention of
childhood conduct problems and depression. His most recent work applies
an ecologically- and developmentally-based intervention for low-income
toddlers at risk for early conduct problems.
Frances Gardner, PhD
Frances Gardner, PhD. Professor of Child and Family Psychology in the
Department of Social Work and Social Policy at the University of Oxford, UK
Professor Frances Gardner is Professor of Child and Family Psychology in
the Department of Social Policy and Social Work, at the University of Oxford,
and Fellow of Wolfson College, and is a clinical psychologist. She has been
Director and Deputy Director of the graduate programme in Evidence-Based
Social Intervention at Oxford since it began in 2003, as well as co-Director of
the Centre for Evidence-Based Intervention.
Her research focuses on the development of anti-social behaviour or conduct
problems in children and young people, particularly how early parenting style,
and other risk and protective factors, influence young people’s mental health
and adjustment. She conducts randomised controlled trials of communitybased parenting programmes in the UK and US, including the US NIH-funded
‘Early Steps’ trial, as well as systematic reviews, and longitudinal studies of
the development of antisocial behaviour and other mental health problem in
young people.
Cheryl McNeil, PhD
Cheryl McNeil, PhD. Professor of Psychology in the Clinical Child program
at West Virginia University, USA
Dr. McNeil’s clinical and research interests are focused on program
development and evaluation, specifically with regard to abusive parenting
practices and managing the disruptive behaviours of young children in both
the home and school settings. Dr. McNeil has co-authored two books,
Parent-Child Interaction Therapy and Short-Term Play Therapy for
Disruptive Children.
Lianne Woodward, PhD
Lianne Woodward, PhD. Associate Professor in Psychology at Canterbury
University, New Zealand
Dr. Woodward is a developmental psychologist who has published a
number of articles that explore the early environments of high‐ risk
populations. Her current longitudinal research exploring the developmental
outcomes of infants born very preterm has won her international
recognition. In 2006, she was awarded the prestigious William Liley award
for her work in predicting neurodevelopmental risk in children born very
premature.
Rosemarie Bigsby, ScD, OTR/L, FAOTA
Dr Bigsby is Clinical Associate Professor in Pediatrics at the Alpert Medical
School of Brown University, USA
Dr. Bigsby is an occupational therapist and Coordinator of NICU Services
at the Center for the Study of Children at Risk at the Alpert Medical School
of Brown University. Her experience as a pediatric occupational therapist
over three decades includes working in a variety of settings as clinician,
supervisor and consultant. For the past 17 years, she has practiced in the
NICU, in the combined roles of therapist, educator and researcher. Her
research focuses on motor development, behavioral cues, physiologic
regulation, and feeding in early infancy. Rose is coauthor of Vergara, E.
and Bigsby, R. (2004).Developmental and Therapeutic Interventions in the
NICU. Brookes Publishing. She also teaches multidisciplinary workshops
on assessment and intervention in the NICU.
Louise Webster, MBChB, FRANZCP,
FRACP(Paeds)
Dr. Webster is a Senior Lecturer in Psychological Medicine at the
University of Auckland, New Zealand and Clinical Director of the Starship
Paediatric Consultation Liaison Team
Louise Webster has trained as both a Child and Adolescent Psychiatrist
and a Paediatrician. She is the Clinical Director of the Starship Paediatric
Consultation Liaison Team, a child mental health team that works with
children and adolescents who have significant medical and surgical
conditions. Louise is also a Senior Lecturer in the Dept. of Psychological
Medicine at the University of Auckland and teaches on a number of
undergraduate and postgraduate courses.
Toni Shepherd, NZDB, Bcom, Grad DipPysch,
NZAP, MNZAC, Waka Oranga
Ko Aoraki toku maunga
Ko Waitaki toku awa
Ko Tahu Potiki te tupuna
Ko Kai Tahu te iwi.
Toni Shepherd is an indigenous psychotherapist, mother of three,
cultural activist, environmentalist, dancer and artist. She currently
works at Starship Children’s Hospital on the Consult Liaison Team
specialising in the NICU. Her areas of expertise are attachment, grief
and loss and the effects of colonisation on indigenous health. Toni
also works in a community practice - Kereru Psychotherapy Services
- where she works to reduce the disparities evident in indigenous
health. She belongs to Waka Oranga a professional indigenous
psychotherapy association which upholds that Te Tiriti o Waitangi
provides the foundation for the political, economic, spiritual and social
context of our lives and work.
Leah Andrews, MBChB, FRANZCP, PGCert
Clin Ed
Dr. Andrews is a child and adolescent psychiatrist at the Starship
Consult Liaison Team and Senior Lecturer and Executive Leader of
Teaching at the Werry Centre, University of Auckland. In her clinical
role she sees medically ill infants, children, adolescents and their
whanau. She also coordinates the Postgraduate Certificate in Health
Sciences Child & Adolescent Mental Health: more than 100 graduates
of this programme are now out there working in services to help
improve the lives of tamariki and rangatahi of Aotearoa
Linda LaGasse, PhD
Dr LaGasse is Associate Professor (Research) in Pediatrics at and
Director of Research at the Center for the Study of Children at Risk at
the Alpert Medical School of Brown University
Dr. LaGasse’s research focus is the effects of prenatal exposure to
drugs of abuse on development including early infant cry, cognitivemotor processes, later behavior problems and psychopathology. Dr.
LaGasse’s primary focus at present is two multi-site, longitudinal
studies of children with prenatal exposure to methamphetamine and
adolescents with prenatal exposure to cocaine. She is also Principle
Investigator of an NIH grant to study prenatal exposure to
methamphetamine and child developmental outcome in New Zealand.
Dr. LaGasse has over 35 peer reviewed publications and chapters,
serves as advisor to other multi-site studies, and is an ad hoc grant
reviewer for several NIH institutes.
Cheryl Dissanayake, PhD
Dr. Dissanayake is Associate Professor and Reader School of
Psychological Science at LaTrobe University, Australia
Dr. Dissanayake is Founder and Director of the Olga Tennison Autism
Research Centre in the in the School of Psychological Science at La
Trobe University. This is the first research facility in Australia
dedicated to Autism Spectrum Disorders. Prof. Dissanayake is a
developmental psychologist, and has been an autism researcher
since 1984. She serves on the Professional Panel of Autism Victoria,
and is co-founder and convener of one of its reference groups, the
Autism Spectrum Disorder Research Group.
Todd Levine, MD
Todd Levine, MD. Instructor in the Department of Psychiatry and
Human Behavior at the Alpert Medical School of Brown University,
USA
Dr. Levine is a Pediatrician and Child & Adolescent Psychiatrist. He
has had a lifelong interest in understanding autism and pursues it in
both research and clinical settings. Dr. Levine’s most current research
focuses on biological and behavioral manifestations of anxiety in
children with autism. In his clinical work, Dr. Levine has developed a
specialized autism clinic focusing on assessments and treatment
planning for children with autism and special behavioral needs.
Steve Sheinkopf, PhD
Dr Sheinkopf is Assistant Professor (Research) in the Department of
Psychiatry and Human Behavior at the Alpert Medical School of
Brown University, USA
Dr. Sheinkopf is a clinical psychologist at the Center for the Study of
Children at Risk at the Alpert Medical School of Brown University and
sees patients in the autism clinic. He is also a member of the
Developmental Disabilities Program at Bradley Hospital and a faculty
member of the Brown Brain Sciences Program. Dr. Sheinkopf has
extensive clinical and research experience in the area of early
childhood, with particular expertise in the area of early diagnosis and
development of young children with autism and developmental
disabilities. His current research includes vocal signals in infants
related to the later development of autism.
Janis Paterson, PhD
Dr Paterson is Professor of Developmental Psychology at Auckland
University of Technology.
Dr Paterson is a Head of the School of Public Health and
Psychosocial Studies and Co-Director of the National Institute for
Public Health and Mental Health Research at AUT University, New
Zealand. Dr Paterson is a Co-Director Director of a the national
Institute for Public Health and Mental Health Research and of the
large longitudinal research project, the Pacific Islands Families Study.
Gerhard Sundborn, PhD
Dr Sundborn is a Senior Research Fellow at Auckland University of
Technology
Dr Sundborn’s work is with The Pacific Islands Families Study, and
has recently completed his PhD investigating the cardiovascular risk
profiles and diabetes status of the major Pacific ethnic groups in
Auckland. Gerhard is eager to ensure that findings from the PIF study
make real changes to the health and wellbeing of Pacific youth and
families.
El-Shadan Tautolo
El-Shadan Tautolo is a doctoral candidate at Auckland University of
Technology.
Mr. Tautolo is enrolled as the first Pacific Islands Family Study Pacific
PhD candidate, with an undergraduate degree in Science, a
postgraduate diploma in Forensic Science and a Masters in Public
Health. His research will assess parenting roles and their effects in
the upbringing of our Pacific children.
Colin Hamlin
Colin Hamlin is Senior Advisor, Policy & Service Development,
Mental Health Group, Population Health Directorate, New Zealand
Ministry of Health
Colin Hamlin is a senior advisor in infant, child and adolescent mental
health in the Mental Health Policy & Service Development team, in
the Ministry of Health. He is a social worker and family therapist with
clinical and management experience in the infant, child, adolescent
and family mental health sector. Prior to commencing his current
role, Colin was instrumental in the establishment of a Multi-systemic
Therapy team for young people with mental health and conduct
problems who were involved with child protection services. Currently,
Colin has a clinical interest in the development of maternal and infant
mental health services and he is involved in interagency policy work
to respond to the needs of young people with conduct problems.
Sally Merry, MBChB, FRANZCZP, MD
Dr. Merry is Associate Professor in the Department of Psychological
Medicine at the University of Auckland, New Zealand.
Dr. Merry is a child and adolescent psychiatrist and, having
established the Werry Centre for Child and Adolescent Mental Health
at the University of Auckland is now the Director of Research at the
Centre. Her main area of research interest has been adolescent
depression and she has conducted a number of major studies in the
area including Cochrane Collaboration reviews of evidence for
interventions and a trial of the effectiveness of a depression
prevention programme. Dr. Merry is currently establishing an Infant
Mental Health Service within the Counties Manukau District Health
Board.
Jo Chiplin, BHSc, MMgt (Health Services)
Ms. Chiplin is Project Manger Counties Manukau District Health
Board, New Zealand.
Jo Chiplin is a registered Comprehensive Nurse, with a background
in general and mental health nursing. She spent seven years
working in mental health services in South Auckland. More recently
she has had a variety of roles in funding and developing mental
health services within the Counties Manukau District Health Board
mental health development team. She is currently involved in the
development of Infant Mental Health services within Counties
Manukau.
Tania Cargo, MA, PGDipClinPsych
Ms Cargo is a Lecturer in the Department of Psychological Medicine,
University of Auckland, New Zealand.
Tania Cargo has worked clinically with Maori tamariki and their
whanau in specialist child and adolescent mental health services and
in Maori community services. Her current interest is in the area of
infant mental health and supporting Maori Mothers and babies. She
works clinically at the Te Aho Tapu Trust, a Maori Psychological
Service in Auckland. She is currently working on a PhD that will
investigate traditional Maori infant-carer relationships.
Lyn Doherty, MA, Dip EdPsych
Ms Doherty is Project Coordinator/Psychologist, Ohomairangi Trust,
New Zealand
Lyn has worked in special education for the last twenty years –ten
years in mainstream services before being part of establishing
Ohomairangi Trust – a Kaupapa Maori early intervention service in
Tamaki Makaurau where she has spent the last ten years leading
and developing Maori service model development. In addition, Lyn
has been an early intervention teacher and registered psychologist
working across a number of settings, cultures, agencies and
providers. She has helped develop resources to improve services
and provision for children and young people, and their whanau,
particularly those in Maori immersion settings.
KAUMATUA
Takutai Wikiriwhi
Ngati Whatua
Rev Takutai Wikiriwhi, of Orakei, received the Insignia of a Companion of
the Queen’s Service Order for services to Maori, on 15 April 2008. Rev
Wikiriwhi has been involved with the Maori community in Auckland and
Northland, as a keeper of traditional knowledge and an orator on marae
for more than 30 years. He is also kaumatua for the University of
Auckland and was awarded an Honorary Doctorate in 1999
Rawiri Wharemate
Ngapuhi, Ngatiwai, Ngai Te Rangi, Tainui
Rawiri is Kaumatua for the Werry Centre and provides cultural advice and
support for the staff and projects relating to Child and Adolescent Mental
Health..
Papaarangi Reid
DipComH Otago, BSc, MBChB, DipObst, FAFPHM
Te Rarawa
Papaarangi is Tumuaki and Head of Department of Maori Health at the
Faculty of Medical and Health Sciences, University of Auckland, New
Zealand. She holds science and medical degrees from the University of
Auckland and is a specialist in public health medicine. She has tribal
affiliations to Te Rarawa in the Far North of Aotearoa and her research
interests include analysing disparities between indigenous and nonindigenous citizens as a means of monitoring government commitment to
indigenous rights.
POSTER ABSTRACTS
Number
1
An Infant Mental Health Service Scoping Project
Sarah Laing and Epenesa Olo-Whaanga, ADHB
Infant mental health has become an important issue in the thinking and delivery of mental health
services in NZ. At the Kari Centre, central Auckland Child and Adolescent Mental Health
Service, a request was put forward by our Manager for funding a service. This service needed to
be scoped and a job share position was created to determine whether there was a need for such
a service and how a service could be offered given the current configuration of Kari Centre.
Aim: To determine whether an infant mental health service was required and what form of service
delivery could be used to meet this specialized need. It would also determine what resources
were required to deliver a service that would fit into the current Kari Centre Service. Method: The
Infant Mental health literature was referred to. Several key documents were consulted.
Additionally gathering statistics for the area and the age group was completed. Stakeholders
were identified and consulted using a semi-structured interview. A Steering Group was also
involved from the Kari Centre.
Results: After reviewing the literature and looking at access rates, it was determined that an
Infant Mental Health Service was required. The proposed model of service delivery was one that
already operated successfully at the Kari Centre as a specialist team.
Conclusions: An Infant Mental Health Service, Koanga Tupu was piloted from these results.
This poster will outline the process used for scoping this service. It will outline the final
configuration arrived at for the service, that has been piloted since April, 2009.
Number
2
Koanga Tupu: A service for Infants and their families/whanau – The first Six months of a
Pilot Service
Epenesa Olo-Whaanga, Sarah Laing, Briar McLean, Meggan Lam, Sunila Wilson, Tanya Wright,
Bev George, Yolisha Singh, ADHB
The Kari Centre, Auckland DHB CAMHS service began a 12 month pilot of an Infant Mental
Health Service- Koanga Tupu in April, 2009. This service had been previously scoped and this
poster will outline the implementation and progress of this project.
Aim: To present the service Koanga Tupu as established from the scoping project. This will
include the referrals and where families were referred from, work completed in the first sixth
months, team processes that occurred in the first 6 months of the pilot. Successes and
challenges will also be highlighted.
Method: Koanga Tupu was set up from a scoping project. Narratives and graphs will convey the
work done by the service in the first six months.
Results: Koanga Tupu received referrals that included a variety of presenting issues and from a
variety of referrers. All of the clinicians working were new to infant mental health work. Work has
been done with infants and their families/whanau both in the home and clinic setting. The service
has been operating on one day per week.
Conclusions: Referrals to Koanga Tupu have met the expectation and capacity of the service. It
appears that there is a need as anticipated from the scoping project for such a service to exist.
The first six months have been a steep learning curve for the clinicians working in Koanga Tupu;
however it has also been very rewarding.
Number
3
Establishing a Perinatal Mental Health Programme in Singapore
Cornelia YI Chee, Vanessa J Keleher, B Broekman, CB Khare
In 2007, public hospital psychiatrists in Singapore were invited to apply for funding for clinical
programmes for high-risk populations. In Mar 2008, the National University Hospital team was set
up with perinatal mental health as its main focus.
Method: Each woman seen in the obstetrics clinics was routinely screened by counter staff using
the Edinburgh Postnatal Depression Scale up to four time-points during each of the trimesters and
the postpartum. Women scoring 10 and above were offered assessment by a case manager and
referred to a psychiatrist as necessary. Assessment and follow-up were via phone or at the
outpatient obstetrics clinics.
Results: 75 women declined to be screened. 5264 women were screened between Mar 2008 and
Sep 2009, of which 49% (n=2556) scored 10 and above on the EPDS. Of these women, brief
face-to-face or phone assessments and psychoeducation were provided to 87% (n=2225) of the
women. However only 4% (n=107) women screened agreed to be fully assessed. Of this subset
of women, 84% (n=90) were seen within 2 weeks of referral. Another 91 women were seen as
direct referrals or self-referred. In all, 53% (n=106) women were diagnosed with adjustment
disorder, with another 19% (n=38) having major depressive disorder.
Conclusions: Screening for perinatal mental health issues is highly acceptable to women. Routine
screening leads to a high rate of pickup of cases and opportunities for outreach, though most
women are not keen to be fully-assessed. We have seen an encouraging number of referrals from
other sources.
Number
4
Perinatal and Infant Mental Health Services in Queensland
Liz de Plater, Queensland Health
Aim: Perinatal and Infant Mental Health (PIMH) is an emerging specialist area of mental health
service delivery in Queensland, Australia. It is a key identified investment of the Queensland
Mental Health Plan 2007 -2011, under the priority action of Mental Health Promotion, Prevention
and Early Intervention. Resources were allocated to establish a hub of expertise in PIMH to
provide co-case management, consultation, liaison and support to public mental health services
and the broader community sector.
Method: A comprehensive, multi-tiered model for PIMH service development, which includes
leadership, workforce, and whole-of-health and cross-sectoral partnership development has been
progressed by a PIMH Advisory Group since February 2008. The focus is on parental mental
health issues in the antenatal and perinatal periods, from conception until 24 months and on the
mental health, development and wellbeing of their infants, conception until 36 months. Service
delivery focuses on prevention and early intervention as well as clinical intervention, is supported
by workforce development initiatives, and occurs within a supportive and culturally sensitive
community context targeting families with identified psychosocial risk.
Results & Conclusions: This poster provides an overview of the progression by Queensland
Health towards implementing state-wide PIMH services, which include that PIMH is now an
identifiable clinical population for mental health services in Queensland; The Queensland Centre
for PIMH has been established to function as a hub of clinical expertise in PIMH.; the Australian
Government National Perinatal Depression Initiative Rollout has been integrated into PIMH
service development; a framework for education, training, supervision and staff support including
the establishment of a web-based Knowledge Hub for PIMH has been started.
Number
5
The Genesis of an Infant Mental Health (IMH) Programme
Sarah Haskell – Occupational Therapist / Manager, Heidi Pace – Child and Family Counsellor
CAMHS West Coast
The development of the IMH programme within the CAMHS West Coast showed parallels with
infancy itself. The genesis, like most pregnancies and births, delivered challenges, joys and
sorrows. The need for nurture to enhance its development was evident throughout. A sense of
feeling held was paramount for staff to deliver a new and innovative service. The challenges
echoed that of the infant and mothers referred; physical-the need for an infant friendly space and
toys; social emotional–the need to build relationships for development and cognitive–putting
knowledge into clinical practice. No additional money was available therefore a number of
creative solutions were implemented. The staff, like expectant parents, began to feather the nest
and prepare for the birth of the new service.
Aim: The aim was to offer a comprehensive IMH programme, facilitating positive infant-parent
relationships, and was informed by a number of theoretical models.
IMH clinical training was an important factor in setting up the programme, providing the
foundations - ensuring safe clinical practice. It ensured the programme was evidence based,
informed by theoretical knowledge and good clinical practice.
The programme, as a relationship – based service for infants and their mothers created a holding
environment for the clients; the importance of ‘holding’ staff through robust supervision was also
recognized for the effectiveness of the service. The programme had a dual purpose; treatment for
the infant and mothers referred and a training environment for staff.
Clinical agendas took second place to the infants and their mothers. The need to work at the pace
set by the infants and their mothers and to nurture them into the infant - parent relationship was
paramount; to ignore this was at our peril.
Number
6
Building secure foundations: Music therapy with pre-schoolers and toddlers.
Claire Molyneux, Marie Bagley, Rebecca Travaglia and Russell Scoones, Raukatauri Music
Therapy Centre.
This presentation will demonstrate how music therapy can promote healthy relationships between
parents and children with special needs while addressing developmental needs.
Music therapy is a strength based approach that can offer parents the opportunity to see their
child in a new light, especially at a stage when many assessments focus on the child’s difficulties.
Parent and child sessions offer a place for bonding where fragile attachment patterns can be
strengthened.
The Raukatauri Music Therapy Centre (Auckland) delivers music therapy to more than 100
children each week, a quarter of whom are six years or younger. This poster will show two
aspects of the Centre’s work with pre-school children:
1. Music therapy with children and parents together, including a pre-school group.
2. Early intervention in a Kindergarten setting for children with autism.
Evaluation and feedback from parents, therapists and early intervention teachers has indicated
that music therapy is effective in engaging children and building the relational capacity necessary
for learning new skills. Research into ‘communicative musicality’ (Malloch & Trevarthen, 2009)
also confirms that an innate musicality resides in us all and is a vital part of human
communication. This research supports the use of music therapy to address developmental
needs.
‘Music can work with dynamic expressive and sensory levels of experience in relationship from
which trust, a sense of safety, and new patterns of healthy attachment or intersubjectivity can
begin to develop. Through the creative clinical use of improvisation, music can provide an
interpersonal framework, a living experience of interpersonal connectedness.’ Robarts, 2009.
Number
7
Can a Post Natal Depression Support Group be Effective in Enhancing Parent-Infant
Relationships?
Pauline Sampson, City of Greater Dandenong Maternal & Child Health, Melbourne and Diana
Russo, Southern Health Child & Adolescent Mental Health Services (CAMHS), Dandenong.
Greater Dandenong is a major multi-cultural municipality of Melbourne, Victoria, with people from
157 different nationalities making up 51.5% of its population. Four out of five women who gave
birth in 2008/9 were born overseas.
Aim: Maternal anxiety, loneliness, isolation, feeling inadequate and depression can impact
negatively on families’ healthy functioning. Participation in a group providing support,
companionship and resources to women in the antenatal and postnatal periods can ameliorate
these effects.
Method: An ongoing weekly group is provided in partnership between the City of Greater
Dandenong Maternal & Child Health Service, and Child and Adolescent Mental Health Services,
Dandenong. Facilitation of the group for mothers with infants up to two years of age is based in
three established models: The Family Partnership Model1; Communications Skills Training for
Cancer Victims2; and Attachment. The group is an open model where mothers attend whenever
they feel the need.
Results: The benefits of the group are visible as mothers actively care for and support each other
and group members demonstrate step-wise problem solving. On-going friendships develop
between group members with regular phone calls and meetings outside the group.
Conclusions: The group has demonstrated its therapeutic value by: crises being averted; family
stability established; early parenting skills developed; communication and play with children
celebrated and enhanced; and the parent-infant relationship strengthened.
Number
8
A Comparison of High Intensity to Low Intensity Behavioral Intervention for Young
Children with Autism
Doreen Granpeesheh, Amy Kenzer, Jonathan Tarbox, & Sheree Adams
Centre for Autism and Related Disorders LTD, NZ
Treatment intensity is a critical variable in the effectiveness of behavioural interventions for young
children with autism. However, treatment intensity is one aspect of treatment implementation that
is particularly variable, due to factors such as limited funding, parent preference, and scheduling
conflicts with non-behavioural treatment and educational services. As a result, actual
implementation of behavioural therapy for children with autism often involves a range of
intensities, from as little as 8 hours a week to as many as 40 hours a week of intervention. The
current study investigated the effects of low intensity and high intensity behavioural intervention
for young children diagnosed with autism. Specifically, two groups of children received services
from the Centre for Autism and Related Disorders, with participants in the high intensity group
receiving an average of 25 or more hours per week of treatment, while the participants in the low
intensity group received an average of 8 - 15 hours per week of treatment. A comprehensive
battery of assessments was conducted prior to treatment and at yearly intervals. Measures
include tests of adaptive behaviour, language, IQ, social skills, and executive function, in addition
to diagnostic measures related to autism. This poster presents outcome data from the first year of
treatment.
Number
9
Infant Feeding and Emotional Care Time by New Mothers
Julie Smith, Australian Centre for Economic Research on Health, Australian National University,
Canberra, Australia
M.Ellwood, President, Pace Productivity, Canada
A recent cluster randomized controlled trial provides strong evidence of cognitive development
benefits (3-6 IQ points) for children who were exclusively breastfed for 4 months or more
compared to those weaned earlier.
This may be due to constituents of breast milk or physical and social interactions inherent in
breastfeeding. Lactation hormones alter maternal behaviours including proximity seeking.
Aim: We explore whether breastfeeding mothers spend more time in close interaction with their
infants than mothers who have commenced or completed weaning.
Data and method: A nationwide Time Use Survey of Australian Mothers (TUSNM) was conducted
in 2005-06. A sample of 188 mothers recorded their activities, 24 hours daily over 7 days, using
an electronic TimeCorder® device.
Results: Among exclusively breastfeeding mothers, breastfeeding occupied 17 hours weekly at 36 months (Table 1). Exclusively breastfeeding mothers also spent 11-12 hours a week carrying,
holding or soothing the infant (‘emotional care’).
Breastfeeding mothers providing solids at 6-9 months spent less time holding their infant than
those exclusively breastfeeding, but more than mothers of non-breastfed infants.
Mothers of exclusively formula-fed infants aged 3-9 months spent an average of 3.8 hours a week
holding their infant (n=23) compared to 7.0 hours (n =183) for those breastfeeding (data not
presented).
Number
10
Introducing a Relationship Approach to Working with Students with Autism
Neil Stuart, Elena Antipova, Debbie May, Julie Timmins,
Oaklynn Special School.
Background: Educationally based programmes can be categorized as fitting within a continuum of
approaches. The primary aim of the developmental (social pragmatic) interventions is building up
the emotional connection between the children with ASD and their caregivers that forms the basis
for development of trusting relationships. Most of these approaches are parent based.
Aim: Adapt and introduce a developmental relationship based parent approach to a Special
School setting.
Method: A cascade training scheme was adopted to facilitate training of staff members within a
Special school based on the evidence that change in the adults results in change in the students
when the IEP goal around building up the relationships are prioritized. Developmental goals were
identified for teachers and teacher aides and video feedback was used as a tool in the monitoring
and coaching of staff. Each year students and adults were baselined and the results monitored as
well as formative assessment. Assessment procedures, student monitoring, staff development,
video feedback and coaching and trans disciplinary practice were all aligned to ensure the
consistency in the implementing the social developmental strategies.
Results: Preliminary results indicate that students and adults are more likely to be involved in
lengthier, more sustained episodes of “serve and return” interactions in emotional contexts.
Conclusions: The preliminary results of the current study confirmed the effectiveness the use of
socio-emotional teaching strategies to increase the social communication and flexible thinking in
students with ASD. The formal evaluation of the results is required.
Number
11
Promoting child and parental mental health in family day care settings in Australia:
Knowledge, strategies, facilitators and barriers
Elise Davis, Naomi Priest, Helen Herrman and Elizabeth Waters, University of Melbourne; Linda
Harrison, Charles Sturt University; Margaret Sims, University of New England; Lisa Smyth,
Windermere Family Day Care; Bernie Marshall and Kay Cook, Deakin University
Aims: The aim of this study was to explore family day carers’ knowledge of child social and
emotional wellbeing and mental health problems and the strategies they use to promote children’s
social and emotional wellbeing.
Method: An exploratory qualitative study was conducted with 13 family day care staff from a local
government area in south western Melbourne. Participants were asked to describe their
understandings of child mental health, early signs of mental health problems for children,
strategies they felt they used to promote mental health of children, as well as identifying
facilitators and barriers to implementing mental health promotion strategies. These interviews
were recorded and thematically analyzed.
Result: Participants were able to identify some potential causes of mental health difficulties,
although these were often the more extreme risk factors. Many carers described personal
strategies they used to promote the mental health of children in their care, including physical
affection, provision of stimulating activities, and providing encouragement and support. Some
family day care workers felt comfortable raising issues surrounding child or parental mental health
with children’s parents, while others feared how parents might responses and so referred the
matter to their field worker.
Conclusion: Further training is required for family day carers about how to identify and address
mental health issues. Development of an intervention to build the capacity of family day care
services to promote the mental health of children is currently underway and this will also be
presented in this poster.
Number
12
Fostering Security – A Programme for Parents and Caregivers of Children with Attachment
Disorder
Bernice Gabriel, Child, Adolescent & Family Service, Hawkes Bay DHB
Lisa Harrington, Child, Youth & Family Service, Hawkes Bay
Fostering Security is a programme designed for parents and caregivers of children with early
histories of trauma, abuse and neglect. The programme is facilitated by staff from both mental
health and child protection services. Fostering Security aims to provide caregivers with
psychoeducation around attachment theory and attachment disorder, to establish a support group
for parents and caregivers, and to provide a bridge between mental health and child protection
service interventions with families affected by attachment disorder. The poster outlines the
programme goals, structure, content and assessment measures used. Preliminary data from
content analysis of interviews with parents and caregivers is also discussed.
Number
13
Improving Clinical Care through routine Outcome Measurement
Nick Kowalenko, Clinical Director,
RNSH CAMHS & Tresillian Family Care Centres, NSW.
Background: Caring for infants’ and their families’ mental health is emerging as a core
component of health service delivery in Australia & New Zealand, both in the primary and
specialist mental health care sectors. Funding for this emerging field, is beginning to enhance
the range of services available to infants and their families. In Australia these include
Beyondblue’s National Perinatal Depression Initiative and at the state level, a range of policy
and practice initiatives supporting perinatal and infant mental health. An increase in public
expenditure for perinatal and infant mental health will almost certainly demand increased
accountability for providing good quality care with a focus on the outcomes of care. In both
New Zealand and Australia, a national system of routine data collection (the minimum data set)
and routine outcome measurement for specialist mental health service provision for those aged
older than 4 years has already been implemented.
Aim: To describe a review of outcome measures for 0 – 4 year olds receiving specialist infant
mental health care that could potentially be utilized for national implementation.
Method: List, review and rank the potential measures outlined, ensuring they conform to the
criteria for national outcome measures implementation.
Results: Suitable measures can be identified. A suite of reliable measures for infants less than
12 months of age is not available.
Conclusions: There are suitable outcome measures available for national implementation for
infant mental health service delivery in Australia (with same limitations for young infants).
Implications for New Zealand will be considered.
Number
14
Establishing a Parent – Infant Emotional Health Class at National University Hospital,
Singapore.
Vanessa Keleher, Reshmi Karayan Kayanoth, Birit Broekman, Cornelia Chee
Department of Psychological Medicine, National University Health System, National University
of Singapore, Singapore
Aim: To establish a regular education class for new parents at NUH to improve understanding
of the important links between parental mental health and infant wellbeing.
Method: When assessing services offered by the Women’s Emotional Health Service (WEHS)
at NUH it was acknowledged there was a gap in promoting parent-infant emotional health and
bonding. With collaboration from the Department of Obstetrics & Gynaecology the WEHS
developed psychoeducational material to be presented in a single session to newly-delivered
parents during their inpatient stay. Following a pilot service in April/June 2009, a thrice weekly
half hour Psychoeducation session focusing on maternal wellbeing, parent-infant bonding and
infant emotional health was launched, co-facilitated by team psychologists and ward staff.
Results: 157 parents have attended the psycho education classes held between April and
September 2009. Anonymous surveys distributed at the end of the sessions revealed that
100% of patients surveyed believed they had increased their knowledge of Parent-Infant
emotional health following attendance. Patients reported that the information provided by
presenters was understandable and 98% of surveyed participants found the group interaction
enjoyable. 89% of patients surveyed reported that they would be interested in attending a more
intensive program on child bonding if it was offered.
Conclusion: The establishment of Parent – Infant Emotional Health classes at NUH has been
successful in raising awareness of the importance of emotional health for both parents and
infants. Attendance at the groups is encouraging and with increased resources the team aims
to hold daily weekday classes to further enhance participation.
Number
15
The Use of Video Feedback to Improve the Mother-Infant Relationship in Women with
Postnatal Depression (PND).
Anne E Buist, Justin L C Bilszta, Nur Rusydina Zulkefli and Fandy Wang, University of
Melbourne
Aim: To investigate the effectiveness of a brief video feedback intervention, in an inpatient
setting in improving mothering confidence and attitude to her infant (child under age of one
year). We also aim to evaluate mother’s acceptability of video feedback.
Methodology: Mothers were recruited from two inpatient PND treatment programs. After
admission, those women who agreed to participate were randomly allocated to video or verbal
feedback sessions if the therapist was available, or to control if she was not. Therapy sessions
lasted up to half an hour, once a week; both verbal and video were given information about
attachment and watched a video on attachment
Results: 56 women with PND being treated as inpatients have been recruited to date.
Preliminary analysis from first 14 women in intervention groups showed significant
improvements in mental health status post intervention within both groups; improvements were
observed in one measure of maternal attitudes/parenting confidence in the video feedback
group. There were no significant differences in other measures. Video feedback was more
useful in helping them understanding infant behaviour but there was a trend that at least initially
these women lost confidence. Analysis not yet available, from all three groups will also be
presented.
Conclusions: A simple, easily administered mother-infant intervention appears helpful for some
women with PND, with a possible added advantage of the use of video. Vulnerable women
however may be at risk of losing confidence initially and need support and likely to need
ongoing work to fully benefit.
Number
16
The impact of a medical procedure on young children.
Birit Broekman, Miranda Olff, Frederique Tan, Bas Schreuder, Wytske Fokkens and Frits Boer
Aim: To examine if a standardized planned medical procedure like an adenoidectomy or
adenotonsillectomy (A&ATE) evokes a stress response in young children.
Method: In this prospective cohort study 43 children, aged 2 to 7 years, scheduled for A&ATE
were recruited from the Ear Nose and Throat Department of the Academic Medical Centre in
Amsterdam, the Netherlands. Before and after surgery neurophysiologic measurements
(cortisol and Respiratory Sinus Arrhythmia) were taken, and parents completed questionnaires
on temperament, behaviour and sleeping problems and posttraumatic stress symptoms.
Results: Most children with an indication for A&ATE had more behavioural and emotional
problems before surgery than the control group. After surgery there was an improvement in
behaviour and sleep, in respectively 75% and 68% of the children, especially in boys.
Posttraumatic stress symptoms were rare. Emotional temperament was associated with more
behavioural problems before surgery (r=0.53, P=0.02), after surgery (r=0.38, P<0.000), lower
cortisol directly after surgery (r=-0.49, P=0.05) and lower Respiratory Sinus Arrhythmia at
follow-up (r=-0.33, P=0.06).
Conclusions: A&ATE appear not to be stressful, but rather seem helpful for reducing preexisting behavioural and emotional problems. For those children with an increase of
behavioural and sleeping problems after surgery, this can only be partly explained by emotional
temperament.
Number
17
New Zealand evaluation of an intensive group parenting programme (Hoki ki te
Rito)
Karolina Stasiak, Sally Merry, Sue Crengle, Chris Frampton, Elizabeth Robinson,
Michelle Lambert, Grace Wang, Mera Penehira, Lyn Doherty, Elaine Sparks, Michelle
Ball, Sulieti Latu, Anna McKenzie, Carlene Morris; Counties Manukau DHB and The
University of Auckland
Aim: Hoki ki te Rito (HKTR) is an intensive parenting course designed to support
families with significant relationship problems with their infants and young children. It is
based on the methods from an established intervention called Mellow Parenting (MP)
developed in Scotland by Christine Puckering. MP has been used oversees to engage
families with a range of severe problems, although there has been little evaluation to
date. We set out to pilot and evaluate the programme in the New Zealand context.
Method: The pilot study (completed in 2009) involved an open trial with two groups with
a total of 14 women. Following the pilot, a bigger evaluation study involved two service
providers and a total of seven groups with a total 43 participants. Data on maternal
mental health (GHQ-30), parenting stress (PDH), child behaviour (SDQ) and child
development (ASQ) was collected at baseline, pre-, post-intervention and at a 3 month
follow-up.
Results: The pilot data revealed statistically significant improvements on maternal
mental health (F(2, 19)=8.815, p<0.002), frequency of parenting stress (F(2, 23) 12.462,
p<0 .000) and intensity of parenting stress (F (2. 21)=10.617, p<0 .001). Women’s
written feedback has been overwhelmingly encouraging and positive. Most women
reported learning valuable parenting strategies and becoming more confident as
parents. Preliminary results from the main evaluation study will be presented as they
come to hand in early 2011.
Conclusions: The results from the pilot project bode well and we hope to replicate them
in the main study. The HKTR programme shows potential to engage mothers with
multiple risk factors and the content can be adapted for the needs of New Zealand
parents.
Number
18
Wellbeing of Mothers Giving Birth to a Very Preterm Infant: Predictors of Maternal
Stress in the Neonatal Intensive Care Unit
Argène Montgomery-Hönger and Carrie A. C. Clark, University of Canterbury, Verena E
Pritchard and Lianne J. Woodward, University of Canterbury, Van der Veer Institute for
Parkinson’s and Brain Research, New Zealand
Aim: The poster presented will explore some of the key decision points where Plunket
services are able to support infant attachment with their primary caregivers and families
within the context of their local communities.
Method: Each meeting between the family and a member of the extensive Plunket
network is an opportunity to engage with parents/caregivers and family in a respectful
relationship. In role modelling being respected, involved and listened to, families can be
guided and encouraged to use the same approach in their interactions with their infants
and others.
Results: The promotion of parent-infant wellbeing is essentially concerned with enabling
parental awareness of and ability to access the personal, family, social and health
resources available to them so that they are best able to meet their own and their
infant’s needs. As well as being the largest Well Child provider in New Zealand, Plunket
also provides a range of services including:
 PlunketLine 0800 number
 parenting education programmes
 parent support groups, playgroups, coffee groups
 car seat rental schemes
 high-school based education programmes aimed at teenagers who are likely to
come in contact with small children
 Parents as First Teachers programmes
 submissions to advocate for policy and law improvements that can positively
affect families
Conclusion: Plunket is well positioned to be able to work with family/whanau to support
their development of responsive and sensitive relationships with their infants.
Approximately ninety per cent of all babies born in New Zealand are enrolled to receive
services from Plunket.
Number
19
The effects of prenatal methadone exposure on later self-regulatory functioning
Verena E Pritchard, University of Canterbury; Alison Gray, University of Canterbury,
and Lianne J. Woodward, University of Canterbury, Van der Veer Institute for
Parkinson’s and Brain Research, New Zealand
Background: Infants born to methadone-maintained mothers are known to be at
elevated risk of neonatal withdrawal. However, little information exists on the longer
term self-regulation of children prenatally exposed to methadone.
Aim: To compare the early self-regulatory capacities of methadone-exposed (ME) and
nonexposed (NE) children at age 2 years. Also of interest was the extent to which
outcomes were explained by a range of background characteristics including infant
clinical, maternal mental health, nutrition, polydrug use, and social-familial factors.
Method: As part of a prospective longitudinal study, an unselected cohort of ME and NE
toddlers were tested on two measures of self-regulatory functioning. A delay-ofgratification task was used to assess impulse control. The DeGangi Infant-Toddler
Symptom Checklist was used to assess emotional, behavioural and attentional
regulation. Data was available for 58 ME and 59 NE toddlers.
Results: At age 2, ME toddlers were characterized by poorer impulse control (p<.0001).
Lower DeGangi behavioural (p<.05) and emotional (p<.03) but not attentional (p=.82)
scores were also evident. Maternal education (p=.01), methadone exposure (p=.04) and
dose level (p=.001) were the strongest predictors of behavioural regulation. For
emotional regulation, predictors included methadone exposure (p=.01), gestational age
(p=.03), maternal nutrition (p=.03) and stimulant use during pregnancy (p=.01). Key
predictors of impulse control were male gender (p=.02), maternal nutrition (p=.02) and
education (p=.01), and single parent families (p=.04).
Conclusions: Self-regulatory difficulties in ME children two years post-natally are
explained by a variety of infant, maternal and socio-familial factors. Follow-up in relation
to cognitive and school outcomes will be important.
Number
20
Prenatal Drug Use and Psychopathology in Women Who use “P”
Trecia Wouldes, PhD. University of Auckland
Background: The abuse of methamphetamine (MA) in pregnant women has increased
in New Zealand and world-wide. However, little has been reported on the psychosocial
characteristics of New Zealand women who use MA during pregnancy. Maternal
substance abuse is associated with multiple psychosocial risks that may adversely
affect child development, including poverty, mental illness, family dysfunction, and family
violence. The purpose of this study was to describe the psychological characteristics
and drug use of New Zealand women who used MA during pregnancy and are enrolled
in the multicenter, longitudinal IDEAL Study of prenatal MA exposure and child
development. The IDEAL Study is a multi-site study of 4 U.S. sites and one Auckland
site investigating the developmental outcomes of children exposed prenatally to (MA).
Method: At 1-month postnatally, 95 mothers who self-reported using (MA) and 104
mothers who reported they had not used (MA) were interviewed. Trained interviewers
obtained information about depression (Beck Depression Inventory-II, BDI-II) and other
psychiatric symptoms (Brief Symptom Inventory, BSI) and the extent of
methamphetamine and other drug use (Addiction Severity Index, ASI and Substance
Abuse Subtle Screening Inventory-3, SASSI-3) during their pregnancy.
Results: The majority of pregnant women who reported using MA in New Zealand were
NZ European (58%) and Maori (35%). Women in the MA group had significantly lower
incomes and were less likely to have a partner. Overall MA exposed mothers reported
significantly more symptoms related to a range of psychiatric problems including
somatization, phobic anxiety, paranoia, psychoticism, anxiety, interpersonal sensitivity
and obsessive compulsive behaviour. Mothers in the MA group were significantly more
likely to continue to use a range of drugs in addition to MA during pregnancy. However,
there was no difference between groups in alcohol consumption during pregnancy (60%
vs 57%). Mothers in the MA group were significantly more likely to have a range of
problems that were affecting their family and social life, employment and their
involvement in antisocial and criminal behaviour. In addition, they were more likely to be
dependent on other drugs.
Number
21
Cerebral Abnormalities and Working Memory Impairments in Children Born Very
Preterm
Samudragupta Bora, University of Canterbury 1, Verena E. Pritchard and Lianne J.
Woodward, University of Canterbury, Van der Veer Institute for Parkinson’s and Brain
Research, Christchurch.
Aims: This study describes the working memory function of a regional cohort of children
born very preterm (VPT) from infancy to early school age in relation to neonatal cerebral
abnormalities detected on neonatal MRI. Of particular interest was the development of fMRI
paradigms to understand the functional neurological consequences of white matter
abnormalities (WMA) on later working memory in VPT children.
Methods: Data was drawn from a prospective longitudinal study of 106 VPT (<33 weeks
gestation) and 113 full term (FT) children. At term equivalent age, VPT children underwent
a structural MRI scan that was assessed qualitatively for WMA and classified into no, mild,
and moderate-severe abnormality groups.
Results: VPT children performed less well than FT children across a range of working
memory tasks at ages 2, 4, and 6 years. Clear associations between WMA severity and
working memory impairments were evident. To understand patterns of brain activations
associated with performance differences, the development of two fMRI tasks adapted from
the Sternberg paradigm to assess the neural correlates of verbal and visuo-spatial working
memory is proposed. Because their design allows for the parametric manipulation of
difficulty levels without considerable alterations to task requirements, they are ideally suited
for use with VPT samples where considerable variability in cognitive ability often exists.
Conclusions: It is expected that VPT children will show both global and regional
abnormalities in cerebral activation compared to FT children during working memory
performance, with findings supportive of a neurobiological basis for observed
neurodevelopmental deficits in children born VPT.
Number
22
A decade later: Testing France and Blampied’s (1999) bio-behavioural model for
the development of infant sleep disturbance.
Jacki Henderson, Karyn France, Neville Blampied, University of Canterbury
Aim: Infants’ sleep self-regulation is influenced by the interaction of biological,
environmental and behavioural processes. Between 70 - 80% of infants are sleeping
through the night by 12 months, by 6 months most have learned to self-initiate sleep
following a night awakening and sleep longer than 8 hours. Others will fail to learn sleep
self-initiation skills, and have a greater predisposition for infant sleep disturbance (ISD).
France and Blampied (1999) presented three bio-behavioural models of developmental
pathways to sleep outcomes. The first two models describe the interactions of factors
influencing the development of sleep self-initiation in the first three months and
development of primary ISD from 3-6 months. Individual differences in infant sleep and
parental behaviours are described as major determinants as whether an infant develops
ISD or not. The aim was to test first two models’ assumptions of the role certain parent
and infant behaviours have in the development of sleep pattern development.
Method: Participants were 75 normally developing infants (52 at 1 month). Parents
completed sleep diaries each month for twelve months. Parental reports of infant sleep
behaviours were objectively validated.
Results: At 1 month co-sleeping, parental presence at sleep onset, and placing the
infant into the cot asleep, together with frequent night awakenings predicted
membership to a sleep disturbed group at 6 months.
Conclusions: The findings support France and Blampied’s models assumptions of the
role parental behaviours and infant characteristics have in the developmental outcomes
of sleep pathways in infancy. The implications of these findings will be described in
detail.
Number
23
Case study of a participant in a Circle of Security Group – Change in parent reflective
capacity and representation of the child and child’s attachment
Sonia Costello, Marymead Child & Family Centre University of Canberra, Australia
This poster will report on the changes observed in one high risk parent/child dyad who
participated in a group Circle of Security (COS) intervention conducted in a community
agency in Canberra, Australia. The full COS protocol is outlined in chapter 28 of the
Handbook of Infant Mental Health, Third Edition (ed Charles Zenah, 2009). Pre and post
assessments included Preschool Strange Situation Procedure (SSP); Circle of Security
Interview and a range of other checklist data and a home visit. The progress of the
development of reflective function capacity and the parent representation of the child was
observed as it was affected by the group intervention. The child’s response to the changes
the parent was making was observed in the three filmed sessions. Qualitative analysis of the
SSPs, mid group taping, pre and post interviews and group sessions and checklists was
conducted to assess the parent’s change in reflective capacity, representation of the child
and the child’s attachment security. The parent showed an increase in reflective capacity,
there was a positive shift in her representation of the child and there was a shift towards
more security in the attachment relationship. The changes in pre and post assessments will
be discussed.
Number
24
Early Social Communication and Development of Toddlers Pre-natally Exposed to
Methadone
Alison C. Gray, J.Knight, R. Jones; S. Büker; C.Spencer; V, Pritchard, L. Woodward, S.Moor,
Canterbury Child Development Research Group, Department of Psychology, University of
Canterbury
Objective: Children born to drug dependent mothers have been shown to be at high, longterm risk. This paper describes the early development of a regional cohort of children born to
mothers maintained on methadone during pregnancy. These findings represent preliminary
results from a larger, prospective, longitudinal study.
Methods: A cohort of 61 methadone-exposed (ME) and 60 non-ME children were followed
prospectively from birth to age 2 years. At age 2, all children underwent an assessment,
which included the Bayley Scales of Infant Development (BSID) and the Early Social
Communication Scales (ESCS).
Results: ME children perform less well than their full term peers on the cognitive (p<001) and
psycho-motor (p<.001) scales of the BSID. ME children are also characterized by significant,
early differences in communicative style on the ESCS. Their communications involve more
demands (p=.03), more teasing (p=.06) and less affect sharing (p=.01). No significant
associations were found between BSID and ESCS scores.
Conclusion: Findings support the presence of global cognitive and motor delays, as well as
early indicators of atypical communication patterns amongst children born to substance
dependent parents by as early as 2 years. Study findings will highlight early, emerging,
developmental challenges in this psychosocially vulnerable group.
Number
25
The home learning environment and early development of children born very preterm
Treyvaud, Karli, Inder, Terrie E, Lee, Katherine J, Northam, Elisabeth, Doyle, Lex W,
Anderson, Peter J, Murdoch Children’s Research Institute, Victoria, Australia, University of
Melbourne, Victoria, Australia, Royal Children’s Hospital, Victoria, Australia, Washington
University, St Louis, USA, Royal Women’s Hospital, Victoria, Australia
Aim: To examine the relationship between the home learning environment, including
parental reading, and early cognitive, motor, and social-emotional outcomes in children born
very preterm.
Method: At two years’ corrected age, parents completed the Home Screening Questionnaire
and the Infant-Toddler Social and Emotional Assessment to measure children’s home
learning environment and social-emotional development, respectively. Children’s cognitive
and motor development was assessed using the Bayley Scales of Infant Development II.
White matter brain injury was evaluated using MRI between 38-42 weeks’ gestational age to
assess children’s biological risk.
Results: After adjusting for overall social risk, a more optimal home learning environment
was associated with better cognitive and social-emotional development. Reading with
children at least five times per week was associated with increased social-emotional
competence. White matter brain injury during the neonatal period influenced the relationship
between the home environment and children’s internalizing and dysregulation problems, but
was not associated with other developmental outcomes.
Conclusions: These findings confirm the importance of the home learning environment on
outcomes for children born very preterm and support greater research on potential
interventions in the home in the first two years of life.
Number
26
Individual Differences in Newborn Imitation
Oostenbroek, J., Slaughter, V., Nielsen, M., & Suddendorf, T., School of Psychology, The
University of Queensland
Aim: The existence of neonatal imitation is a contentious issue. Establishing the prevalence
and reliability of imitation in the newborn period is important in understanding infants’ later
social development and mental health outcomes. The aim was to investigate whether 1week-old neonates were able to selectively imitate gestures modelled to them and to explore
whether their temperaments influenced their imitative ability.
Method: Facial, manual and vocal gestures were modelled to sixty neonates. Each gesture
was presented five times in 15 seconds followed by a passive response period of 15
seconds. This procedure was then repeated for each gesture. Data for temperament
classification was collected via a parental survey used in the Australian Temperament
Project.
Results: Preliminary analyses from 27 neonates revealed that neonates made significantly
more tongue protrusions than mouth openings, index finger protrusions and vocalizations
when tongue protrusion was modelled (F (4, 22) = 7.61, p = .000) and made significantly
more grasps than index finger protrusions and vocalizations when grasping was modelled (F
(4, 9) = 6.05, p = .000). Pearson’s r showed a medium-sized positive relation between easy
(versus difficult) temperament and tongue protrusion response frequency (r(25) = .306, p =
.061, one-tailed).
Conclusions: This sample of 1-week-old neonates selectively imitated tongue protrusions
and grasps, but not mouth openings, index finger protrusions or vocalizations. Whether
tongue protrusion is a social response, a product of arousal or a reflex at this age is still
unclear. The data suggest that neonatal temperament may be linked to imitative ability.
Number
27
Staff Perceptions of Those at Risk for Challenging Interpersonal Relations in the NICU
and Strategies to Decrease these Challenges
Joshua B. Friedman, Te Puaruruhau, Child Protection Unit, Starship Hospital;
Susan Hatters Friedman, Mason Clinic, Waitemata District Health Board
Aim: The staff of Neonatal Intensive Care Units (NICUs), as well as families, are under
significant stress during the infant’s stay in the NICU. A shorter length of stay has been
correlated with improved parent-infant interactions and parental mental health. We sought
to examine staff perceptions of challenging interactions with parents of NICU infants, and
strategies to care for families in which such interactions occur.
Method: A cross-sectional survey was devised by paediatricians, perinatal psychiatrists, and
social workers at 2 NICUs. The survey was then distributed to staff at a NICU in a teaching
hospital in a large American Midwest city. Likert scale items concerned medical,
psychological and social factors that contribute to challenging interactions with parents. We
also inquired with whom staff discuss their frustrations, and rating of proposed solutions to
improve interactions.
Results: Respondents were nurses, paediatricians (including trainees), and nurse
practitioners (N=90; 56% response rate). Psychological, social and medical factors were
ranked by relative contribution to challenging interactions. Frequent family meetings,
grieving opportunities, clearly defined rules, support groups, education and social work
referrals were perceived as the most effective strategies.
Conclusions: Potential benefits of targeting those at highest risk with effective interventions
include improved parent functioning with less stress, improved bonding, optimal
development, and decreased rates of abuse. As well, staff stress may be alleviated. Finally,
a role for mental health professionals in the NICU is suggested, including in leading support
groups, assisting with grieving, and in a liaison role regarding staff understanding of parental
psychological issues.
Number
28
Emotional interactions between preschool children and their teachers: How they
influence classrooms environments and learning experiences
Maria Luisa Ulloa, Massey University, Wellington
Young children spend a considerable amount of time outside home in early childhood
settings, where teachers play a fundamental role in supporting the acquisition and
consolidation of emotional competence. Through the provision of positive relationships and
supportive class atmospheres teachers help preschoolers to enhance and extend their
social and emotional skills, during preschool years when adaptive functioning or
psychopathology is established. The emotional interactions between children and adults in
early childhood settings are particularly important for children who have limited opportunities
for developing emotional skills from home based experiences. Research shows that
classrooms with positive emotional climate, where teachers are engaged in higher quality
emotional interactions positively influence children’s social competence and behaviour. This
study aimed to investigate what aspects of teacher –child interactions influence preschool
children’s emotional competence and how these experiences can be harnessed to improve
children’s emotional understanding in everyday situations. A naturalistic observational
methodology was implemented and observations were conducted on a time –sampling basis
by two observers. Three culturally diverse settings were observed over a 10 weeks period.
The observational material permitted the identification of patterns of interactions during
highly emotional events, which contributed or obstructed the emotional understanding in
preschoolers. Samples of these interactions were ordered in categories; Aspects as
emotional engagement, adult-child relationship, direct expression of feelings, value on
individuality, attunement (affective awareness) and the use of emotionally relevant activities
were examined and analysed in the light of child development and educational literature.
Teachers and preschool children showed a selection of strategies for coping with anxiety
and managing stressful situations. Individual differences in the quality of the emotional
climate between centres were significantly shaped by the manner in which adults and
children respond to these emotional situations.
Number
29
A Preliminary Study Assessing Changes in Child Attachment Classification &
Caregiver Reflective Functioning Capacity Following Circle of Security Intervention
Elizabeth Challis, Marymead Child & Family Centre University of Canberra, Australia
Child attachment style and caregiver Reflective Functioning were examined pre and post the
Circle of Security intervention (a group program grounded in attachment theory) to assess
changes. The Strange Situation Procedure (SSP) assessed child attachment style pre and
post the intervention and participants (N=8) were interviewed immediately following the SSP
on each occasion.
The interviews were rated to assess caregiver’s Reflective Functioning by a research
psychologist from the Anna Freud Centre in London who is reliable in coding Reflective
Functioning capacity and was blind to whether the transcripts were pre or post intervention.
The following hypotheses were examined: (1) There will be a shift from Disorganised to
Organised child attachment classification styles following the intervention. (2) There will be
a shift from Insecure to a Secure child attachment classification style following the
intervention. (3) There will be an increase in Caregiver Reflective Functioning capacity
following the intervention. (4) Higher Caregiver Reflective Functioning capacity scores will
be associated with an Organised child attachment classification. This preliminary study found
that at post intervention: (1) All shifts in child attachment classification were in a positive
direction, but not statistically significant. (2) The overall increase in caregiver RF capacity
was not statistically significant, but effect size was clinically significant. (3) The relationship
between higher caregiver RF and an Organised child attachment classification was not
statistically significant. The results indicate positive trends towards a Secure (B) child
attachment style, along with increased RF capacity for participants. Further research with
more participants would be clinically useful.
Number
30
Perinatal and Infant Mental Health Training: the NSWIOP Postgraduate Masters
programme
Sarah Mares, Beulah Warren, Martha Birch, NSW Institute of Psychiatry
Knowledge, skill and confidence about infant and relational assessment and intervention are
central to competent perinatal and infant mental health practice. Reflective processes are a
central aspect of this. This presentation outlines the development of postgraduate Perinatal
and Infant Mental Health (PIMH) education and training at the Institute of Psychiatry, Sydney,
Australia and will focus on the principles that underpin and inform the Graduate Diploma and
Master of PIMH. A Certificate programme is being developed.
An overview of the programme, opportunities and challenges will be provided.
Post-Graduate training in Infant Mental Health (now PIMH) was first offered by the NSW
Institute of Psychiatry in Sydney Australia in 1998 and there have been over 100 graduates
from across Australia and New Zealand in that time. The course is offered at Grad Dip and
Master level by distance education, to a multidisciplinary group of students who come from a
wide range of professional disciplines and social and professional contexts in both countries.
The programme content and delivery emphasise the development of reflective skills in
students through;: a supportive relationship based approach to training; a twelve month
infant observation providing students with the opportunity to understand early development,
develop observational skills about infants and families as well as their own responses to the
infant and family; ongoing clinical supervision and development of a reflective clinical journal,
and study and assessment tasks that require the student to integrate new knowledge into
their clinical practice and to discuss these in a multidisciplinary context.
Number
31
Mental Health well-being amongst fathers within the Pacific Islands Families Study
El-Shadan Tautolo, Philip J. Schluter, Gerhard Sundborn, The Auckland University of
Technology
The aim of this study was to investigate the prevalence of potential psychological disorder
amongst a cohort of primarily Pacific fathers in New Zealand over their child’s first 6-years of
life. The analysis is based on data collected at 12-months, 2-years, and 6-years postpartum
during the Pacific Islands Families Study, and uses the 12-item General Health
Questionnaire (GHQ12) to assess the prevalence of psychological distress amongst
participant fathers at each measurement wave. Various socio-demographic and potentially
confounding variables were also investigated to determine their effect on the risk of
developing a potential mental health disorder. The majority of fathers within the study
reported good overall health and well-being and their prevalence of symptomatic disorder
was initially low at 12-months (3%) but increased significantly at 2 years (6.6%) and at 6
years (9.8%) in crude and adjusted analysis (both P-values <0.001). In the adjusted analysis,
smoking status, marital status, employment status, and ethnicity, were all significantly
associated with the risk of developing symptomatic mental health disorder.
Number
32
Behavioural problems among two-year-old Pacific children living in New Zealand
Janis Paterson. Sarnia Carter, Wanzhen Gao, Lana Perese, The Auckland University of
Technology
The aim of this study was to determine (1) the prevalence of behavioural problems among
two-year-old Pacific children living in New Zealand, (2) ethnic differences in behavioural
problems, and 3) relationships between maternal and socio-demographic variables and
problem child behaviour. Data were gathered from the Pacific Islands Families (PIF) Study.
Mothers of a cohort of 1398 Pacific infants born in Auckland, New Zealand during 2000 were
interviewed when the children were two years of age. Maternal reports (1028) of child
behaviour were obtained using the Child Behaviour Checklist (CBCL). In the PIF cohort,
15.6% of children were in the clinical range with one or more deviant scores from the seven
syndrome scales, and 14% were in the borderline range. The prevalence rates of
externalizing and internalizing problems and the factors associated with problem behaviour
scores are presented.